In recent years the Indian Journal of Medical Ethics has been to the forefront in grappling with tricky issues in medical ethics and politics – topics that the best known medical journals and authorities should deal with but steer clear of.
One of us (DH) had a growing awareness of IJME’s lead on tricky issues, but became even more aware of it at the time of the Cochrane crisis last year, when the editor Amar Jesani approached me for a comment. There was no steer as to what was wanted and no editing of what was said just a genuine interest it seemed to get some important issues into wider circulation and get a debate rolling – a debate that Cochrane wanted to close down.
A few weeks ago, IJME asked me to write a review of Love is the Drug – a new book, certain to sell well and perhaps a book that might even help create a new field of relationship-modification drugs (EQ) to complement the smart drug (IQ) scene and a booming Wellness market.
Again I was free to write whatever I wanted. There were some welcome suggestions from IJME about points to clarify and a general steer toward making it shorter and tighter but no effort to interfere with how I chose to handle some sensitive issues.
The journal was even happy to try and get the review published for St Patrick’s Day – St Patrick being the guy who eliminated snakes from Ireland. This is HERE.
The tricky problems relationship modifying drugs throw up in Love is the Drug are not centred on the efforts of pharma to market sex drugs for women with supposed hypoactive sexual desire disorders or other efforts to commodify women and men’s sexual functioning.
There is almost no mention of marketing here.
The authors seem to assume the scurvy knaves of the pharmaceutical industry, who were causing us all problems some years back, have been clapped in irons by evidence based medicine and regulators and we can all now get back to more innocent days – romance filled days of Listening to Prozac when we were all about to be transformed into an entirely new species and could walk the earth with fresh-faced wonder.
There is in fact very little biochemical or pharmacological detail in here and some of what there is is wrong – statins do not inhibit sex.
This lack of detail produces a screen onto which bioethical fantasies are projected. The broader fantasy is that we need a work around for our primitive biological machinery, which where sex is concerned centres on procreation. In the progressive future hurtling towards us, we can’t be held back by our biology.
We will be liberated by “smart” chemicals.
The trouble with this vision is that its our ancient biology that had the smarts to tame and incorporate some beyond-dumb chemicals. Taking these chemicals out of biological systems, figuring that’s where the biological smarts lie, is a dumb move.
Cabbages are a good example of why this is. At the last count cabbages contained something like 47 different pesticides, many of which would not be approved by FDA if they were extracted and submitted for licensing.
But cabbages have the “brains” to use these pesticides effectively, although smart though they clearly are they couldn’t anticipate all eventualities – such as the evolution of a species that would like pesticides. Some of us humans find pesticides tasty (these are what give cabbage its taste and some of us a brassica problem after indulging our tastes).
Testosterone and Estrogen are similarly poisonous but equally can almost irresistibly contribute to the “taste” of other humans. Extracting them, however, figuring they contain the smarts of what it means to be feminine or masculine doesn’t always work out.
Estrogen and Testosterone are a pair of dumb chemicals. It is the biological systems that are smart – smarter often than the individuals they support, even some who write books.
Extracting these poisons and giving testosterone back to men with apparent Low T can cause suicide, dependence and withdrawal problems – yes withdrawal.
Giving estrogen to women with normal estrogen levels can cause addictive cravings, dependence, and withdrawal problems in some women and can also make other women emotionally labile and suicidal.
Even giving thyroid hormone to people with thyroid deficiencies can cause problems – as one of the early posts on RxISK Weight Gain on Thyroxine brings out. Everyone in healthcare knows that one of the signs of underactive thyroids is weight gain and thyroid hormone replacement therapy (THRT) can help people to lose the weight gained.
This underpins a thriving Wellness market niche that pushes thyroid hormones for weight loss – most thyroid hormone prescribing these days is probably for people who have nothing wrong with their thyroid glands. Trouble is that even in cases of genuine thyroid problems, the replacement hormones can do just the opposite to what you’d expect – causing weight gain as the post with its over 200 endorsing comments brings out.
All chemicals, both natural and unnatural ones, can do the opposite to what people expect – a drug that slows your heart rate may increase mine. This is because the chemicals are being chucked into systems that may be wired up in opposite ways but still achieve the right functional goal. The function lies in the system not the chemical. Left handers manage to live in a right handed world
And to add another layer of complexity, biologically there is no such thing as an individual. Our systems, and hormones and everything else in us are shaped by the other systems in the group in which we live.
Love is the Drug ends up twisting itself into a pretzel over some very important points. The authors envisage a future where we will have the chemical capabilities to convert anyone who is homosexual to a heteronormative state and where there might therefore be pressure to convert. They quite rightly say that we need to avoid this.
A few pages later, they tack the opposite way saying that people who are seeking to transition (convert) to the right them need to have a full panoply of smart chemicals available to enable them to be the real and authentic them. Their ancient biological machinery (the author’s words not mine) cannot be let get in the way.
The book finishes on a note of
chemicals change chemicals and thinking changes chemicals and because of this none of us are in a position to decide whether there is an authentic way to achieve authenticity.
To be continued next week with Snakes in a Love Drug 2 .